One of the biggest threats to the sterility of a clean-room is the workers who carry out duties inside it. There is always a risk of contamination due to inadequate and improper gowning procedures. Lab coats, gloves and other personal protective equipment exist to minimise this risk, but without correct gowning procedures, their efficacy is greatly limited. In this article, we provide a comprehensive breakdown of proper gowning technique, with notes on common problem areas.
While the order of steps in gowning is sometimes debated, the generally accepted first action is hand-washing. We start with this and list an additional 12 steps that should be followed by workers. It is important to note that workers should shower in the morning before coming in to work, and refrain from wearing perfumes, cosmetics or hair spray as these all represent contamination risks. Indoor shoes should be brought with and donned before entering the gowning area. Practical clothing must be worn – no shorts, skirts or high heels. Chewing gum is not permitted.
Step 1: Wash hands
Before entering the gowning area, wash your hands with anti-bacterial soap for a minimum of 30 seconds, taking care to clean under the fingernails (use a pick if necessary) and wash all the way up to the elbows. Dry your hands using an automatic air dryer if one is available.
Step 2: Enter the gowning area
Enter the area without touching the door. Move slowly and deliberately, wiping your shoes on the mat provided.
Step 3: Put hair back
Put on the bouffant provided, ensuring that no hair is exposed. Gloves may be donned before this stage – see Step 5 below for the correct procedure.
Step 4: Put on overshoes
Carefully remove overshoes/shoe covers from their packing and put them on after wiping/spraying your shoes with the sterilizing/cleansing products provided.
Step 5: Put on first pair of gloves
This is one of the most critical parts of the gowning procedure and care must be taken to ensure it is done properly. The gloves need to be thick rubber, neoprene, nitrile or polyethylene. Sanitise your hands using the gel or spray provided. When removing the gloves from their packaging and putting them on, touch only the inside and hold them at the cuff – this is correct aseptic technique.
Step 6: Don the hood
When putting on the hood, take care to touch only the inside, and ensure that it is sealed tightly. It is advisable to sanitise your hands again before this step, and all other steps.
Step 7: Put on the face mask
Ensure that it fits snugly.
Step 8: Put on the coverall
Make sure the coverall does not touch the floor or walls. Slide it out of the packaging carefully, holding it by the inside neck. Roll it out and slide it over your body slowly.
Step 9: Put on the overshoes
Though we covered this step earlier on in step 4, there may be instances where you will be required to put on a second pair of overshoes. Some gowning rooms have a step over bench that doubles up as a physical barrier between gowning area and clean-room. While sitting on this bench facing the gowning area, lift your foot off the floor, Don your shoe cover, and swing that leg over the bench so your foot only makes contact with the floor on the clean side of the bench. Follow this procedure for your other foot as well.
Step 11: Put on the safety goggles
Ensure they fit properly.
Step 12: Put on the second pair of gloves
Either remove the first pair of gloves, sanitise your hands again and then put on the new pair, or put them on over the first pair after sanitising. Take care to roll the gloves down over the cuffs of your coat sleeves.
Step 13: Inspect yourself
Most clean-rooms have a full length mirror. After gowning use this mirror to do a final inspection of yourself to ensure you have donned all the necessary items and that the masks and goggles fit correctly. If there is a checklist available make sure you conform to this list of gowning items.
When doffing, or removing, the items of personal protective equipment, reverse all of the steps. Put any disposable items in the bins provided and put reusable items in the correct receptacles. Exit the gowning area slowly and wash your hands again.
If there is a tear in any of the items during gowning, remove it and use a new one. Remember that garments should be changed weekly, with the exception of gloves, which should be changed at least once during the work shift, and disinfected often. All staff should receive regular training in gowning technique to ensure the continued sterility of the work environment.
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